• Development and Usability Testing of a Mobile Health Game Application for Older Adults on Warfarin

      Opoku-Agyemang, Ernest; Johantgen, Mary E.; Nahm, Eun-Shim (2020)
      Background: Chronic disease management constitutes a special challenge in the United States due to deficiencies in the healthcare system. Chronic disease self-management (CDSM) using technology and gaming principles is a promising way to overcome these challenges. Yet, there are few disease-specific apps to benefit the populations likely to benefit from such innovations. Purpose: This proof of concept study evaluated the feasibility of a Warfarin game app for older adults. The aims were to: 1) Design and develop a mobile game app to educate patients on Warfarin; and 2) Conduct usability testing of the game app among patients on Warfarin receiving care at an anticoagulation clinic. Methods: Following the design and development of a Warfarin app called Coumadin Hero, the usability testing of the app was conducted with 25 participants. Heuristics and user testing were conducted. The Technology Acceptance Model (TAM) was the theory that informed the study design and implementation. An adaptation of the Perceived Health Web Site Usability Questionnaire (PHWSUQ) was used to assess the participant usability. Descriptive and correlational statistics were used to analyze game play data and responses to survey questionnaires. Results: The median percent correct of Vitamin K food identification was 79%. Generally, participants had higher knowledge of Vitamin K levels in green vegetables (92% - 96%). User technology experience and demographic characteristics were not associated with Vitamin K food knowledge or level of satisfaction. The overwhelming majority of users found the app easy to learn and use. The ease of reading and finding information were 68 – 72%, respectively. Conclusion: Because self-management is vital for people taking Warfarin, using a game app as a supplement to traditional teaching could have significant positive impact on their health. As apps are increasingly easy to develop and smartphone use increases, apps should be developed to help people manage chronic diseases. Findings from this study support people’s interest and ability to use apps.
    • Pharmacotherapeutic Management and Care Transitions among Nursing Home Residents with Atrial Fibrillation

      Dutcher, Sarah Kathryn; Zuckerman, Ilene H. (2014)
      Nursing home (NH) residents are a vulnerable population who experience a high rate of transitions across care settings. This population is also at risk for adverse drug events, given their multimorbidity and polypharmacy. However, the relationship between the quality of medication use and transitions in this population is unknown. This study investigates this relationship in the context of atrial fibrillation (AFIB), as pharmacotherapeutic management of AFIB, especially the use of warfarin, can be problematic, and poor management of AFIB can result in hospitalization. This study has three specific aims, all conducted among long-stay NH residents with AFIB: 1) To describe and identify factors associated with pharmacotherapeutic management of AFIB in the NH; 2) To quantify changes in pharmacotherapeutic management for AFIB across a hospital transition; 3) To determine the bidirectional relationship between quality of AFIB management and hospital transitions. This study used 2006-2009 Medicare administrative data, the NH Minimum Dataset, and NH facility data. The first and third aims used a nonconcurrent prospective cohort design with monthly measures of medication use and hospitalizations. The second aim used a pre-post design to compare medication use before and after a hospitalization. The cohort comprised 16,174 older, long-stay NH residents with AFIB, contributing 219,571 person-months of observation. Forty-eight percent were receiving any antithrombotic, of which warfarin was a majority (78.0%). Among person-months with warfarin use, 84.3% had regular INR monitoring. Approximately 12% of hospitalized individuals experienced a change in their antithrombotic regimen. A hospitalization was associated with 28% higher odds of warfarin use but 29% lower odds of INR monitoring. Conversely, warfarin use was associated with 10% lower odds of any hospitalization, but not with an AFIB-related hospitalization. INR monitoring was not significantly associated with hospitalization. Results from this study suggest that targeting clinicians to increase adherence to management guidelines for chronic conditions such as AFIB and expanding medication reconciliation interventions can improve the quality of care for NH residents and avoid unnecessary care transitions.